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ORAL PATHOLOGY > FINAL EXAM > Flashcards

FINAL EXAM Flashcards

1
Q

which HPV types are sexually transmitted? (2)

A

condyloma acuminatum

HPV 16, 18

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2
Q

cutaneous lichen planus affects where?

A

–Flexor surface of wrists, lumbar region,
shins, but other locations

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3
Q

___________precursor lesion for cutaneous squamous cell carcinoma. “________” texture. Tx either _________ or ____________ such as _______. Use of _________, limit __________

A

Actinic keratosis

sandpaper

surgical excision

topical, immune-activating agents

Aldara

sun blocking agents

sun exposure.

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4
Q

cutaneous lichen planus may take how long to resolve?

A

7-10 yrs

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5
Q

• Treatment:
Hypohidrotic ectodermal dysplasia
(2)

A

–Genetic counseling patients and
parents

–Treatment plan may include fixed,
removable, implants, ortho, etc.
depends on individual case

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6
Q

where does bullous pemphigoid occur?

A

primarily on skin, but mucous membrane involvmenet occurs

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7
Q

Has also been termed “Scleroderma” sclero
= hard; derma = skin

A

Systemic sclerosis

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8
Q

erythema migrans occurs where? Characteristically dorsal and lateral
anterior 2/3 of the tongue

A

Characteristically dorsal and lateral
anterior 2/3 of the tongue

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9
Q
A

systemic lupus erythematosus

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10
Q

treatment for squamous papilloma

A

conservative excision

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11
Q

squamous papilloma common sites (5)

A

tongue, uvula, soft palate, and lip, but any location

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12
Q
  • ________, cause?, blends with surrounding
  • ________.
A

Idiopathic osteosclerosis - dense vital bone, no identifiable etiology, blends with surrounding
trabeculae.

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13
Q

HPV enters where? and infects what?

A

epithelial cells- mucosa + skin

infects basal cells

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14
Q

Immune-mediated
– Different process than EM (con’t):
• Difference between SJS and TEN: (3)

A

–Degree of skin involvement
• SJS <10% and usually younger patient • TEN >30% and usually over 60 y.o.

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15
Q

E6 and E7 in HPV allow cell to what/

A

cell to grow in uncontrolled manner and avoid cell death

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16
Q

– CREST syndrome • Treatment:

A

–Symptomatic - similar to systemic
sclerosis

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17
Q

clinical features of verruca vulgaris?

A

painless papule

papillary projections or rough surface

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18
Q
A

cutaneous lichen planus

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19
Q 
\_\_\_\_\_-most common in \_\_\_\_\_-food, etc. gets caught between the overlying
soft tissue (operculum) and crown of partially impacted tooth. Ideally, remove \_\_\_\_ and opposing \_\_\_\_. May need to initially decrease \_\_\_\_\_\_ e.g. with \_\_\_\_, then \_\_\_\_\_.
A 
Pericoronitis-most common in mandibular third molars-food, etc. gets caught between the overlying
soft tissue (operculum) and crown of partially impacted tooth. Ideally, remove offending tooth and opposing third molar. May need to initially decrease local inflammation e.g. with rinses, then surgery.
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20
Q

____________-focal increase in melanin; also can occur as ________ in response to _________

A

Melanotic macule-focal increase in melanin; also can occur as reactive melanosis in response to local
trauma.

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21
Q

Peutz-Jeghers syndrome
can cause what?

A

bowel obstruction due to
intussusception (“telescoping” of proximal segment into distal segment)

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22
Q

Lupus erythematosus
• Diagnosis:

for CCLE?

SLE?

A

–Clinical appearance skin lesions in CCLE
characteristic

–SLE - criteria by American Rheumatism
Association for clinical and lab findings

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23
Q

-variant of seborrheic keratoses that occur in ___________.

A

Dermatosis papulosa nigra

African Americans

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24
Q

Immune-mediated – EM, SJS and TEN
• Histopathologic features: (4)

A

–Subepithelial or intraepithelial vesicles
–Necrotic basal keratinocytes
–Mixed inflammatory cell infiltrate
–May see perivascular inflammation

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25
Q

acute exposure of nicotine exposure

A

mouth, throat irritation, dry cough

adverse physiologic effects on lung function?

no chance in CBC, lung or cardiac function

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26
Q

– Systemic sclerosis
• Radiographic features (3)

A

–Diffuse widening of periodontal
ligament

–Resorption of posterior ramus,
condyle, coronoid process or chin in
10-20%

–May see root resorption

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27
Q

what is the term for producing and inhaling vapors by placing e-liquid drops directly onto heated atomizer coils?

A

dripping

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28
Q

measures the amount and pattern
of antibodies in your blood that work against your own body; a non-specific finding but can be used as a screening tool.

A

anti-nuclear
antibodies

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29
Q

Chronic cutaneous lupus erythematosus is exacerbated by

A

sun exposure

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30
Q
A

pemphigus vulgaris

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31
Q

what does crest sydnrome stand for

A

–Calcinosis cutis

Raynaud’s
phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia

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32
Q

which HPV type is a high risk for cancer?

A

HPV 16/18

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33
Q

-patients may be symptomatic e.g. tongue sensitive to spicy or acidic food, when
lesions are present.

A

Geographic tongue-patients may be symptomatic e.g. tongue sensitive to spicy or acidic food, when
lesions are present.

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34
Q

-intracellular edema

A

Leukoedema-intracellular edema

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35
Q

what is an e-cigarette?

A

electronic nictoine delivery system

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36
Q

mucous membrane pemphigoid (MMP) occurs where?

A

–Any mucosal surface, occasionally affects
skin

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37
Q

chronic cutaneous lupus erythematosus

AKA

A

discoid lupus

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38
Q

– Oral lichen planus (OLP/ELP)
• Treatment: (4)
rule out?

Reticular LP tx?

ELP treat with?

A

–Rule-out candidiasis; treat if + culture
–Reticular LP usually no Tx needed
• Patient may feel “rough” areas of
hyperkeratosis, but no pain
–ELP treat with potent topical steroid
• “off label”

• Systemic steroids not needed
–Biopsy any suspected pre-
malignant/malignant lesion

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39
Q

_________-punched out _______ that do not regenerate. Seen
in persons with ______ and/or _______

A

Necrotizing ulcerative gingivitis (NUG)-punched out interdental papillae that do not regenerate. Seen
in persons with poor oral hygiene and/or poor diet and stress.

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40
Q

Describe lesions of – Chronic cutaneous lupus erythematosus

(CCLE) (2)

A

–Skin – scaly, erythematous patches in
sun-exposed areas, esp. H&N
• Heal then reappear in different area;
may result in atrophy of and scarring
with hypo- or hyperpigmentation

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41
Q

• Immune-mediated
– Bullous pemphigoid (BP)
• Treatment:

A

–Management similar to cicatricial
pemphigoid, but most BP cases resolve spontaneously in 1-2 years

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42
Q

– Peutz-Jeghers syndrome
• Prognosis:

A

–Intussusception may self-correct or
may require surgery to prevent ischemic necrosis
–If cancer develops, treat appropriately

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43
Q

describe appearance of MMP mucous membrane pemphigoid?

A

–May see intact intraoral blisters
–Desquamative gingivitis

– descriptive
term: erythema, desquamation, ulceration
• May be seen in several disorders

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44
Q

what erythema migrans caused by?

A

Erythema is due to atrophy of filiform
papillae and shearing off of the parakeratin - remaining epithelium thins, results in red appearance

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45
Q

“freckles” brown pigmentation that develops following sun exposure. More common in _______ and ________ individuals.

A

ephelides

children + fair skinned individuals

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46
Q
A

erythema migrans

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47
Q

describe prognosis of pemphigus vulgaris with corticosteroid therapy?

A

–Complications of long-term steroid
may lead to mortality –Today, 5-10% mortality, usually due
to complications of therapy (side
effect of steroids, immune-
suppression; azathioprine suppresses
bone marrow and is a carcinogen)

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48
Q

erythema migrans occurs in _______ pts who have ______

A

1/3

fissured tongue

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49
Q
A

hereditary hemorrhagic telangectasia (HHT)

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50
Q

deposition of a
band of immunoreactants at the basement membrane zone of normal skin;

A

Positive lupus band test

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51
Q

most common of autoimmune blistering conditions

A

bullous pemphigoid

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52
Q

-vital lamellar bone.

A

Mandibular tori-vital lamellar bone.

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53
Q

Two forms of oral lichen planus

A

–Reticular (lacy white lines)
–Erosive (ELP)- erythematous, may
ulcerate

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54
Q

-inflamed _________ of the palate with______ around the
_____. Most commonly seen in _______; can also be seen with long-term use of ________

A

Nicotine stomatitis-inflamed minor salivary glands of the palate with hyperkeratosis around the
orifices. Most commonly seen in pipe smokers; can also be seen with long-term use of hot beverages.

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55
Q

–Acute onset ulcerative disorder skin and
mucous membranes

A

erythema multiforme

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56
Q

-collection of _________. Maxillary sinus lining will be superior to the
________. May get referred pain to maxillary teeth with_______ e.g. during ______.

A

Antral pseudocyst-collection of fluid below maxillary sinus. Maxillary sinus lining will be superior to the
fluid collection. May get referred pain to maxillary teeth with altitudes e.g. during flying.

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57
Q
A

CREST syndrome

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58
Q
A

Oral lichen planus – lichenoid mucositis

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59
Q

heriditary pattern of

Hereditary hemorrhagic telangiectasia (HHT)

A

autosomal dominant

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60
Q

where do oral mucosa lesions of condyloma acuminatum usually occur? (3)

A

labial mucosa

lingual frenum

soft palate

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61
Q

– Systemic sclerosis
• Histopathologic features:

A

–Diffuse deposition of collagen
throughout the superficial connective tissue

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62
Q

describe apperance of white sponge nevus?

A

Thick, white appearance of buccal
mucosa bilaterally

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63
Q

Immune-mediated
– Different processes than EM
• Prognosis SJS and TEN:
–Mortality rate

A

• SJS 1% - 5% • TEN 25% - 30%

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64
Q

Name 4 clinical features of hypohidrotic ectodermal dysplasia

A

–Fine, sparse blond or light color hair, eyebrows, eyelashes –Hypodontia –Oligodontia (lack of development of 6 or more teeth) –Conical roots

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65
Q

– Erythema multiforme (EM)
• Etiology (3)

A

–50% cases- unknown
–25% - preceding infection;
• *Viral (herpes) • Bacterial (Mycoplasma pneumoniae)
–25% - medication-related
(antibiotics and analgesics)

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66
Q

– Systemic sclerosis
• Diagnosis (con’t):
–Serologic studies (3)

A

• Autoantibodies directed against Scl-70

• Anticentromere antibodies
• Limited cutaneous systemic
sclerosis

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67
Q

aka venereal warts

A

condyloma acuminatum

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68
Q

– Erythema multiforme (EM)
• Clinical features EM minor (con’t):
–Mucosa

(2)

A

• Erythematous patches oral mucosa
that undergo necrosis and result in
large, shallow erosions and ulcers with
irregular borders • Gingiva and hard palate usually spared

(2)

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69
Q

erythema migran occurs in what % of the population

A

1-3%

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70
Q

Most significant aspect of mucous membrane pemphigoid? MMP is what?

A

ocular involvement of symblepheron

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71
Q

– Peutz-Jeghers syndrome
• Histopathologic features: (2)

A

–Gastrointestinal polyps are not
precancerous
• Benign growths of intestinal
glandular epithelium

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72
Q

describe presentation of pemphigus vulgaris and where?

A

• Superficial, ragged erosions and
ulcerations • Any mucosal surface

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73
Q

– Erythema migrans (geographic tongue, benign
migratory glossitis)
• Histopathologic features:
(2)

A

–Similar to psoriasis “psoriasiform
mucositis” description on x report

–Parakeratosis with extensive
microabscess (neutrophils) formation in
the superfical spinous layer

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74
Q

-part of Waldeyer’s ring. ____ at ______

A

Foliate papilla-part of Waldeyer’s ring. Active lymphoid tissue at posterior lateral tongue.

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75
Q

condyloma acuminatum affects where? (3)

A

anogenital region, mouth, larynx

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76
Q

– Erythema migrans (geographic tongue, benign
migratory glossitis)
• Prognosis: (2)

A

–Good
• Reassure patient this is a benign
condition

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77
Q

oropharyngeal cancer is located where?

A

base of tongue, soft palate, palatine tonsils, and pharyngeal wall

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78
Q

white sponge nevus is common. T/F

A

false-relatively rare

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79
Q

• Immune-mediated
– Different processes than EM
• Treatment SJS and TENS: (4)

A

–Discontinue causative drug!
–IV re-hydration
–Topical anesthetic or analgesic for pain
–Avoid steroids in TEN – have been found
to be detrimental

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80
Q

systemic lupus erythematosus may involve what locations intraorally

A

• Palate, buccal mucosa, gingiva • Vermilion zones “lupus cheilitis”

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81
Q

describe squamous papilloma

A

exophytic with fingerlike projections giving a “cauliflower” or “wart-like” appearance

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82
Q

-comprised of dense, vital lamellar bone

A

Maxillary torus-comprised of dense, vital lamellar bone

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83
Q

periocular hyperpigmentation is associated with what condition?

A

Hypohidrotic ectodermal dysplasia

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84
Q

– Chronic cutaneous lupus erythematosus
• Prognosis

A

Good
–~ 50% resolve after several years
–~ 5% - 10% of patients with CCLE
transform to SLE

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85
Q

– Systemic sclerosis
• Diagnosis:
(4)

A

–Generally stiffened skin with
development of Raynaud’s phenomenon suggestive of Dx
–Skin biopsy
–Lab studies
–Serologic studies

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86
Q
A

verruca vulgaris

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87
Q

oral effects of e-cigarettes

A

inflammatory response in periodontal tissues, may promote periodontal disease, impair wound healing vs. reduce inflammation and improve angiogenesis

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88
Q

oral lesions of hereditary hemorrhagic telangiectasia are most dramatic and easily identified where? (3)

A

Vermilion zones
• Tongue
• Buccal mucosa

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89
Q

what population is affected by erythema multiforme?

A

young adults 20-30s

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90
Q
A

mucous membrane pemphigoid

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91
Q

_______________used
to detect autoantibodies bound to the patient’s tissues

_________________used
to detect antibodies circulating in the blood

A

Direct immunofluorescence (DIF)

Indirect immunofluorescence (IFF)

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92
Q

what amount of teens report using e-cigarettes?

A

1/4

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93
Q
A

hypohidrotic ectodermal dysplasia

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94
Q

– Pemphigus vulgaris (PV)
• Treatment:

A

Systemic corticosteroids, often with
azathioprine or other steroid-sparing agents
–Topical corticosteroids have little effect

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95
Q
A

Erosive lichen planus – erosive lichenoid mucositis

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96
Q

systemic lupus erythematosus + CCLE have a ___________ nature

A

waxing/waning

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97
Q

-loss of continuity of an epithelial or epidermal covered surface.

A

Ulcer-loss of continuity of an epithelial or epidermal covered surface.

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98
Q

most common soft tissue mass arising from soft palate

A

squamous papilloma

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99
Q

– Oral lichen planus (OLP/ELP)
• Prognosis

A

varies
–Some patients are well-controlled, others
can be difficult to control

–Recurring candidiasis a challenge
• Dry mouth, dentures, ATB, inhaler • Topical steroid predisposes to candida

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100
Q

clinical features of condyloma acuminatum (6)

A

contagious, sessile, pink, short blunted, non-tender, exophytic

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101
Q

–Acro-osteolysis
• Destruction of the digit tips,
including bone

A

– Systemic sclerosis

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102
Q

– Hereditary hemorrhagic telangiectasia (HHT)
• Diagnosis HHT requires

A

3 of 4 features:
–Recurrent spontaneous epistaxis
–Telangiectasias of mucosa and skin
–AV malformation involving the lung, liver
or brain –Family history of HHT

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103
Q

Name 6 developmental Mucotaneous Conditions

A

Ectodermal dysplasia • Hypohidrotic ectodermal dysplasia • (polygenetic oligodontia) – White sponge nevus – Peutz-Jeghers syndrome – Hereditary hemorrhagic telangiectasia

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104
Q

what are the 4 components of e-cigarettes?

A

cartridge (reservoir) which holds a liquid solution

heating element (atomizer)

power source (lithium battery)

mouthpiece to inhale

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105
Q

squamous papilloma has a low ______ + ________

A

infectivity + virulence

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106
Q

pemphigus vulgaris is present in what populations/gender?

A

Average age 50 y.o.
–No gender predilection

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107
Q

– Mucous membrane pemphigoid (MMP)
• Treatment:

(4)

A

–Depends on extent of involvement
• Oral lesions alone - topical steroids,
tetracycline/niacinamide or dapsone
may be sufficient

• Frequent dental prophylaxis, q 3-4
mos.

–Refer patient to ophthalmologist for
exam and follow-up
• If ocular involvement, systemic
immunosuppressive therapy indicated

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108
Q

scarring of mucous membrane pemphigoid occurs where?

A

Skin • Symblepheron (conjunctiva) • Scarring on oral mucosa rare

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109
Q

L1 and L2 in HPV comprise what?

A

virus capsid (shell) required for virus transmission, spread, and survival

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110
Q

what cancer occurs anterior to the tonsillar pillars?

A

oral squamous cell carcinoma

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111
Q

– Erythema multiforme (EM)
• Clinical features EM minor (con’t):
–Skin (3)

A

• Variety of appearances “multiforme”
• Round, dusky-red patches on skin of
extremities “target lesions” • Bullae with necrotic centers

112
Q

what is Raynaud’s phenomenon and what condition(s) is it associated with

A

• Discoloration of the fingers
and/or toes after exposure to
changes in temperature or
emotional events. Not specific for
systemic sclerosis
systemic sclerosis + crest syndorome

113
Q

which condition is a genodermatosis?

A

genetially determined skin disorder -white sponge nevus

114
Q

________-focal deposition of mucous. Cause is ________ to associated ___. Treatment is conservative-remove ____ and _________

A

Mucocele-focal deposition of mucous. Cause is damage to associated minor salivary gland duct. Treatment is conservative-remove extravasated mucous and associated minor salivary glands.

115
Q

white sponge nevus is symptomatic or asymptomatic

A

asymptomatic

116
Q

Parulis (intraoral opening of sinus track)-rule out _________

A

Parulis (intraoral opening of sinus track)-rule out an odontogenic source of infection.

117
Q

______________ - cheek, tongue, lip nibbling/chewing-__, at a
site(s) accessible to ____.

A

Morsicatio buccarum, linguarum, labiorum - cheek, tongue, lip nibbling/chewing-shredded keratin, at a
site(s) accessible to teeth.

118
Q

• Immune-mediated
– Systemic sclerosis
• Prognosis: (3)

A

–Death due to internal organ deposition
of collagen
• Cardiac involvement has worse
prognosis • Most deaths due to pulmonary
involvement

119
Q

what immunofluorescence studies will be positive in pemphigus vulgaris

A

direct (DIF) and indirect (IIF)

120
Q

primary CLinical features of oral pharyngeal squamous cell carcinoma

A

enlarged lymph nodes in neck,

dysphagia

subtle, asymtopmatic initially

121
Q

– Bullous pemphigoid (BP)
• Histopathologic features:

A

–Subepithelial cleft similar to MMP

122
Q

Systemic lupus erythematosus
–Oral involvement in what % of patients

A

5-25%

123
Q

Milder variant of systemic sclerosis

A

CREST Syndrome

124
Q

–Diffuse smooth, hard texture of skin,
“hidebound”

A

systemic sclerosis

125
Q

–Dental findings can mimic ectodermal
dysplasia

A

• Polygenetic oligodontia

126
Q

what benefits if any are there of using e-cigarettes?

A

9 contaminants in e-cigarettes

vs 11,000 in tobacco cigarettes

mimics habit so addresses physical/behavioral addiction

127
Q

–Pulmonary, renal, cardiac and GI fibrosis
may be seen, with pulmonary hypertension

A

systemic scelerosis

128
Q

• Relatively rare condition characterized by
inappropriate deposition of dense collagen
–Replaces and destroys normal tissue

A

systemic sclerosis

129
Q

verruca vulgaris affects what population?

A

any age, children

130
Q

what is risk of developing cancer in peutz jegher syndrome compared to control population?

A

18x greater

131
Q

– Cutaneous lichen planus
• Clinical features:

A

–Purple polygonal pruritic papules with
Wickham’s striae (lacy white lines)

132
Q
A

squamous papilloma

133
Q
A

systemic sclerosis

134
Q

– Systemic lupus erythematosus
• linical features (4)

A

–Protean manifestations initially
• Fever, weight loss, arthritis, fatigue,
general malaise
–Malar “butterfly rash” spares nasolabial
folds

–Skin lesions flare with UV exposure

135
Q

what population is affected by oral lichen planus

A

–Adults, with female predilection (3:2)

136
Q

what two ingredients are in e-cigarettes?

A

propylene glycol

flavoring agents

137
Q

what population/gender is affected by cutaneous lichen planus?

A

adults 30-60 yrs

female predilection

138
Q

Immune-mediated
– Different processes than EM (con’t):
• Distinguishing features between EM and
SJS/TEN: (2)

A

• SJS and TEN almost always triggered
by a drug, rather than infection • SJS and TEN skin lesions begin as red
macules on trunk rather than
extremities

139
Q
A
140
Q

–Varying degrees of xerostomia is associated with?

A

Hypohidrotic ectodermal dysplasia

141
Q

verruca vulgaris is extremely common where?

A

skin, especially on hand

142
Q

may have co-infection w/high risk type

A

low risk: condyloma acuminatum

143
Q

– Lupus erythematosus
• Treatment:
(6)

A

–Sunscreens, avoid excessive UV exposure
–NSAIDS
–Antimalarial drug therapy, low dose
thalidomide if resistant to topical Tx

–Topical steroids for skin and/or mucosa

–Systemic steroids or
immunomodulating agents for more severe cases
• Complications from long-term
steroids –Kidney transplant may be needed

144
Q

– CREST syndrome

• Prognosis

6-year survival rate ?%

12-year survival rate ?%

A

better than systemic sclerosis
–6-year survival rate 80%
–12-year survival rate 50%

145
Q

which HPV types are low risk for cancers

A

squamous papilloma

verruca vulgaris

condyloma acuminatum

146
Q
A

chronic cutaneous lupus erythematosus

147
Q

• Immune-mediated
– Erythema multiforme (EM)
• Prognosis: (4)

how long does it last?

______ who get recurrences when?

if ____ is trigger mainteance _____

-not __________ except?

A

–EM minor and major

  • self-limiting (2 – 6
    weeks)

–20% of patients get recurrences (esp.
spring and autumn)
• If HSV is trigger maintenance antiviral –Not life-threatening except severe cases
Developmental and Immune-mediated Mucocutaneous Conditions

148
Q

singular erythema migrans is known as

A

“persistens”

149
Q

prognosis of verruca vulgaris?

A

may recur

spontaneous remission possible

150
Q

dermatologic term for common wart

A

verruca vulgaris

151
Q

what causes pemphigus vulgaris?

A

In PV, autoantibodies destroy desmosomes.

desomosomes bond epithelial cells together. Abs inhibit adherence, so split develops in epithelium

152
Q
A

systemic lupus ertyematosus

153
Q
A

bullous pemphigoid

154
Q

–Microstomia “purse-string appearance

A

systemic sclerosis

155
Q

– Hereditary hemorrhagic telangiectasia (HHT)
• Prognosis:

A

–Generally good, 1-2% mortality
sometimes noted due to complications related to blood loss
–If brain abscess develops, 10% mortality
can be anticipated, despite early diagnosis and appropriate treatment

156
Q

– Bullous pemphigoid (BP)
• Immunopathologic features:

A

–Positive DIF and IFF with
immunoreactants deposited at the BMZ

157
Q

• Immune-mediated
– Erythema multiforme (EM)
• Clinical features EM major: (3)

A

\–2 or more mucosal sites in conjunction
with skin lesions
• Mucosal, lip and skin lesions as seen
in EM minor –Ocular involvement can produce
symblepheron

158
Q

prognosis for squamous papilloma (2)

A

recurrence unlikely

spontaneous remission possible

159
Q

List two conditions of cardiac involvment from systemic lupus erythematosus?

A

• Pericarditis • Libman-Sacks endocarditis

160
Q

describe reticular lichen planus

A

interlacing white lines

161
Q

1-associated with loss of vertical dimension. ________ some may have co-infection with ___________.
If external only, can use topical application of combination
.___________________

A

Angular cheilitis-associated with loss of vertical dimension. Candida, some may have co-infection with Candida and Staph
If external only, can use topical application of combination
Candida and Staph. antifungal/corticosteroid cream.

162
Q

Three Forms of lupus erythematosus

A

• Chronic cutaneous lupus
erythematosus (CCLE)

• Systemic lupus erythematosus (SLE)
• Subacute cutaneous lupus erythematosis (SCLE)
intermediate between CCLE and SLE will not be
discussed in this lecture

163
Q

Hereditary hemorrhagic telangiectasia (HHT)
• Histopathologic features:

A

–Collection of thin-walled blood vessels in
the superficial connective tissue

164
Q
A

apthuous ulcer

165
Q

white sponge nevus can have other oral sites affected. T/F

A

True Nasal, esophageal, laryngeal,
anogenital mucosa may be involved

166
Q

benign skin lesion with a “stuck on” appearance. Looks like “dropped on candlewax”.

A

Seborrheic keratosis

167
Q

describe erosive lichen planus?

A

shallow ulcers, peripheral
erythema and radiating white lines

168
Q

oral mucosa lesions usually occur where for verruca vulgaris?

A

vermilion border

labial mucosa

anterior tongue

169
Q

leukoplakia- rule-out dysplasia. White patch that does not rub off and cannot be diagnosed clinically or
microscopically as anything else. Perform a _____ to identify exact nature of the lesion.

A

leukoplakia- rule-out dysplasia. White patch that does not rub off and cannot be diagnosed clinically or
microscopically as anything else. Perform a biopsy to identify exact nature of the lesion.

170
Q
A
171
Q

• Immune-mediated
– Oral lichen planus (OLP/ELP)
• Histopathologic features (5)

A

–Varying degrees of hyperkeratosis,
atrophy or ulceration

–!bsent or pointed rete ridges (“saw-
toothed)

–Degeneration of the basal cell layer
• Degenerating keratinocytes

–Band-like infiltrate of lymphocytes –Varying thickness of spinous layer

172
Q

worst prognosis for combining factors of HPV

A

HPV-, msoker

173
Q

–Protuberant lips due to midface
hypoplasia is associated with?

A

Hypohidrotic ectodermal dysplasia

174
Q

-ectopic sebaceous glands. Can be seen anywhere in the ______, ________ most
common location also may be seen on _____

A

Fordyce granules-ectopic sebaceous glands. Can be seen anywhere in the mouth, buccal mucosa most
common location also may be seen on lips

175
Q

–Prodromal symptoms ~ 1 week before
onset (fever, malaise, headache, cough, sore throat)

A

erythema multiforme

176
Q

Describe radiographic features of hypohidrotic ectodermal dysplasia? (2)

A

–Hypodontia/oligodontia –Conical roots –Abnormally-shaped crowns (conical, tapered, pointed, smaller)

177
Q

– CCLE and SLE
• Histopathologic features:
(2)

A

–Lichenoid features with vasculitis
–May show subtle differences (e.g.
subepithelial edema) which may help lead to the Dx

178
Q

at
least two mucosal sites plus skin
involvement

A

Stevens-Johnson syndrome (SJS)

179
Q

most significant aspect of systemic lupus erythematosus?

A

–Renal involvement 40% - 50% of patients
is most significant aspect of disease

180
Q

hypohidrotic ectodermal dysplasia affects what gender?

A

M >F

181
Q

group of inherited disorders in which two or more ectodermally derived structures do not develop or fail to develop

A

ectodermal dysplasia

182
Q
A

traumatic ulcer

183
Q

• Immune-mediated
– Bullous pemphigoid (BP)
Prognosis: (3)

A

–Many patients experience remission
–Problems may develop with use of
immunosuppressive therapy in older population
• Mortality 3 times higher than age and
sex matched population

184
Q

found along occlusal plane.

A

Linea alba-found along occlusal plane.

185
Q

– Chronic cutaneous lupus erythematosus
(CCLE)
• linical features (con’t):
–Mucosa (2)

A

lichenoid mucositis,
essentially identical to ELP, but
seldom occur without skin lesions

–Painful, esp. with acidic, salty or
spicy foods

186
Q

– Mucous membrane pemphigoid (MMP)
• Histopathologic features:

A

–Subepithelial cleft formation –
separation of the epithelium from the connective tissue at the basement membrane zone (BMZ)

187
Q

Benign hamartomatous polyps of
gastrointestinal tract, esp. jejunum and ileum

A

peutz jeghers syndrome

188
Q

-immunologically mediated process. Often has “striae” or lacy clinical presentation.
Does not __.

A

Lichen planus-immunologically mediated process. Often has “striae” or lacy clinical presentation.
Does not wipe off.

189
Q

-found under sub-optimally fitting RPD or full denture, may also
reflect nearly _______. tx= (2)

A

Inflammatory papillary hyperplasia-found under sub-optimally fitting RPD or full denture, may also
reflect nearly constant wear. Conservative excision, new denture.

190
Q

survival rate for HPV + and oropharyngeal cancer, HPV-?

A

80%

40%

191
Q

– Peutz-Jeghers syndrome
• Treatment:
(2)

A

–Genetic counseling, parents and
patient –Monitor for intussusception and for
tumor development

192
Q

______ -benign melanocytic lesion. Often notice a decrease in __________ as it progress from _______ to _______ to _________

A

Nevus

pigmentation

junctional

compound

intradermal.

193
Q

high risk HPV

A

HPV 16 and 18

194
Q

• Immune-mediated
– Systemic sclerosis
• Treatment: (4)

A

–ACE inhibitors for HTN, esp. due to renal
–Esophageal dilatation
–Oral hygiene instruction
–Fabricate prostheses with design to
accommodate microstomia

195
Q

treatment of verruca vulgaris?

A

skin lesions-topical therapies, surgery

oral lesions-surgery, laser, cryotherapy, electrosurgery

196
Q

gender and age preference of mucous membrane pemphigoid? (MMP)

A

–Older age than PV, average 50 – 60 y.o. –2:1 female predilection

197
Q

Effects of nicotine exposure?

A

release of epinephrine

release of dopamine (pleasure reward)

198
Q

Crest Syndrome affects what population

A

Women, 6th to 7th decade of life

199
Q

diffuse bullous
involvement of skin and mucosa

A

• Toxic epidermal necrolysis (TEN) -

(Lyell’s disease)

200
Q
A

polygenetic oligodontia

201
Q

heat intolerance lack of sweat glands is characteristic of what disorder?

A

hypohidrotic ectodermal dysplasia

202
Q

types of lichenoid mucositis (7)

A

• Lichenoid drug reaction; lichenoid amalgam
reaction; oral mucosal cinnamon reaction;
lichenoid foreign body gingivitis; oral lesions
of graft-vs.-host disease (GVHD); oral lesions
of LE; some epithelial dysplasias

203
Q
A

white sponge nevus

204
Q

AKA cicatricial (scarring) pemphigoid

A

Mucous membrane pemphigoid (MMP)

205
Q

for mucous membrane pemphigoid

_______ DIF

__________ IIF

A

–Positive DIF; negative IIF

5-25% of
patients will have circulating
autoantibodies)

206
Q

–Dystrophic or brittle nails
is associated with?

A

Hypohidrotic ectodermal dysplasia

207
Q

• Immune-mediated
– Different process than EM (con’t):
• Clinical features SJS and TEN:

(3)

A

–Within 2 weeks skin sloughing and flaccid
bullae develop

–Patients may appear badly scalded -
usually treated in burn unit

–Almost all patients have mucosal
involvement, esp. oral

208
Q

Name 14 Immune Mediated Mucotaneous Conditions

A

– Pemphigus vulgaris – Mucous membrane pemphigoid – Bullous pemphigoid – Erythema multiforme – Erythema migrans (geographic tongue) – Lichen planus • Cutaneous lichen planus • Oral lichen planus – Lichenoid mucositis – Lupus erythematosus • Systemic (SLE) • Chronic cutaneous (CCLE) – Systemic sclerosis – CREST syndrome

209
Q

most common STI in US

A

HPV

210
Q

inheritance pattern of white sponge nevus?

A

autosomal dominant

211
Q

how is Peutz-Jeghers syndrome inherited?

A

AD

212
Q
A

peutz jegher syndrome

213
Q

most common cause of death for systemic lupus erythematous?

5 yr survival rate?

15 year survival rate?

A

renal failure

95%

75%

214
Q
A

erythema multiforme (minor)

215
Q

– Erythema migrans (geographic tongue, benign
migratory glossitis)
• Treatment: (3)

A

–None generally necessary

–Occasionally sensitive or painful to hot,
spicy foods
• Potent topical steroid

216
Q

white sponge nevus appears in what population?

A

birth or early childhood,
sometimes adolescence

217
Q 
Pemphigus vulgaris (PV)
• Histopathologic features:
A

–Microscopically, intraepithelial clefting
above the basal layer (i.e. within the epithelium)
–Acantholysis (breakdown of spinous
layer; cells appear to fall apart) – is also usually evident

218
Q

Lupus erythematossus diagnosis serum studies show _________________ present in

SLE _________

CLE _________

A

Serum studies show anti-nuclear
antibodies present in 95% of SLE patients, negative in CCLE

219
Q

-prominent vessels, often an indication of __________

A

Telangectatic capillaries

sun damage

220
Q

benign melanocytic lesion. Macular (flat), increase in number in _________ with __________

A

lentigo

caucasians with age

221
Q

-fissured tongue-patients often also have ____

A

Fissured tongue and xerostomia-fissured tongue-patients often also have geographic tongue.

222
Q

where does oral lichen planus usually occur?

A

Bilateral buccal mucosa, tongue, gingiva
common but any intraoral surface and
lips

223
Q

when is Peutz-Jeghers syndrome noted?

A

usually noted in childhood

224
Q

-overgrowth of chromogenic bacteria and filiform papillae.

A

Black hairy tongue-overgrowth of chromogenic bacteria and filiform papillae.

225
Q

what does ectodermal dysplasia affect?

A

it is hypoplasia or aplasia of • Skin • Hair • Nails • Teeth • Sweat glands

226
Q

-silver in amalgam stains _____ in associated_______. If unusual
presentation, may need to excise to rule out ______

A

Amalgam tattoo-silver in amalgam stains reticulin fibers in associated connective tissue. If unusual
presentation, may need to excise to rule out melanoma.

227
Q

–Claw-like deformity of fingers due to
collagen deposition, ulceration of the fingertips

A

Systemic sclerosis

228
Q

describe the clinical features of peutz jegher syndrome in the head and neck?

A 
–Hyperpigmented macules of lips and
oral mucosa (also can occur around eyes, nostrils, anus, hands, feet), may fade with age
229
Q

– Mucous membrane pemphigoid (MMP)
• Immunopathologic features:

A

–Linear deposition of immunoreactants at
the BMZ

230
Q

Autoantibodies in pemphigus vulgaris bind __________

A

desmosomal
components (desmoglein 1 & 3)

231
Q

• Bullae rupture sooner than on skin
(constant trauma?) leaving large
shallow ulcerations with smooth,
distinct margins

A

bullous pemphigoid

232
Q

associated with NON-oncogenic human papillomaviruses.

A

Papilloma

233
Q

– White sponge nevus
• Treatment:
(4)

A

–None necessary but cosmetic concern
–Tetracycline rinses reported to help
–Reassure the patient that this is a
harmless condition –Good prognosis

234
Q

-bony protuberances arise from cortical plate.

A

Exostoses-bony protuberances arise from cortical plate.

235
Q

percentage of pemphigus vulgaris lesions that are oral and what is unique to them?

A

50%

oral lesions “first to show, last to go”

• In other words – the oral lesions
often are the initial manifestation
of the disease and the most
difficult to resolve with treatment

236
Q

systemic sclerosis affects who and what population

A

Women affected 3 times more frequently
than men; adult age group

237
Q

description of erythema migrans

A

–Multiple, well-demarcated zones of
erythema surrounded at least partially by
a slightly elevated yellow-white
serpentine or scalloped border

238
Q

– Hereditary hemorrhagic telangiectasia (HHT)
• Treatment: (4)

A

–Genetic counseling, parent and patient
–Mild HHT – no treatment
–Moderate HHT – selective cryotherapy or
electrocautery bothersome lesions –Severe – septal dermoplasty to prevent
epistaxis

239
Q

white spone nevus is due to

A

a defect in normal keratinization of oral mucosa

240
Q

chronic exposure of nicotine on lung? on heart?

A

lung- increased risk of developing COPD, emphysema

heart-fibrosis

241
Q

small collection of
dilated capillaries

A

telangiectasia

242
Q

-need to do ____ to confirm. Assess ____

A

Periapical cyst-need to do biopsy to confirm. Assess vitality of adjacent teeth.

243
Q

prognosis for condyloma acuminatum?

A

condylomata infected w/HPV 16/18 have higher risk for malignant transformation to SCC

oral lesions have not shown this

244
Q

confirmation of diagnosis of HPV + and OPSCC

A

HPV-16 infection is not characterized by presence of HPV- 16 alone

E6, E7 in tumor cells expressed

and serum presence of E6 or E7 antibodies

245
Q

___-benign collection of dense fibrous connective tissue. tx=

A

Fibroma-benign collection of dense fibrous connective tissue. Conservative removal.

246
Q

– White sponge nevus
• Histopathologic features: (3)

A

–Exfoliative cytology sometimes more
diagnostic than scalpel biopsy –Parakeratosis with acanthosis
(thickening of spinous layer) –Perinuclear eosinophilic condensation
of cytoplasm is pathognomonic

247
Q

what gender and type of population are affected for bullous pemphigoid?

A

no gender population

older population affected age 75-80 yrs

248
Q

most common cancer in humans.

A

basal cell carcinoma

249
Q

– Erythema multiforme (EM)
• Clinical features EM minor: (3)

A

–Skin (extremities)
–Mucosa (oral, conjunctival, genitourinary,
respiratory) –Hemorrhagic crusting of vermilion zones

250
Q

what is a nikolsky sign and what condition is associated with it?

A

+ Nikolsky sign - inducing a bulla by
applying firm, lateral pressure to
normal appearing skin
pemphigus vulgaris

251
Q

most often older patients, _____ frequent site. If _____, will NOT blanch with diascopy.

A

Varix-most often older patients, lower lip frequent site. If thrombosed, will NOT blanch with diascopy.

252
Q

– Different processes than EM
• Prognosis SJS and TEN (con’t):
–If patient survives (3)

Skin heals in _______

  • ______ take longer
  • Ocular damage in _____ of patients
A

• Skin heals in 3 – 5 weeks • Oral lesions take longer • Ocular damage in 50% of patients

253
Q

treatment for condyloma acuminatum?

A

excision, cryotherapy, laser

topical agents for anogenital lesions

254
Q

Mucous membrane pemphigoid (MMP)
• Prognosis: (3)

A

–Condition can usually be controlled
–Blindness results in patients with
untreated ocular disease –Rarely undergoes spontaneous resolution

255
Q

• Immune-mediated
– Erythema multiforme (EM)
• Treatment

A

supportive therapy):
–Systemic or topical steroids early on
(controversial) –IV re-hydration –Topical anesthetic or analgesic for pain

256
Q

• Flaccid vesicles, bullae on skin;
rarely seen intact intraorally

A

pemphigus vulgaris

257
Q

Systemic lupus erythematosus
affects what population (3)

A

–Females affected 8 – 10 times more than
males

–Women of color more than Caucasians

–Average age at diagnosis 31 y.o.

258
Q

hereditary hemorrhagic telangiectasia has mutation in one or two genes which are for what?

A

blood vessel wall integrity

259
Q

high-risk HPV types make proteins?

A

E6, E7, L1, L2

260
Q

– Pemphigus vulgaris (PV)
• Prognosis:
(5) w/out corticosteroid therapy

A

–Usually fatal if not treated
• *Severe infection • Loss of fluids/electrolytes • Malnutrition due to mouth pain
–Prior to corticosteroid therapy,
60-90% mortality

261
Q

– Systemic lupus erythematosus
• Prognosis: (4)

A

Variable
–Depends on which organs affected and
how frequently SLE is reactivated

–Worse for men than women

–Worse for blacks than whites

262
Q

Chronic Cutaneous lupus erythematosus primarily affects what?

A

skin/mucosa

263
Q

T/F. squamous papilloma is painful

A

false-painless

264
Q

–Genetic testing now would reduce
this error

A

mistaking ectodermal dysplasia for polygenetic oligodontia

265
Q

systemic lupus erythematosus oral invovlement lesions may appear

A

non-specific or lichenoid

266
Q

-associated most often with poorly fitting dentures. tx =

A

Inflammatory fibrous hyperplasia-associated most often with poorly fitting dentures. Conservative
excision, construct well-fitting dentures.

267
Q

A number of conditions can mimic oral
lichen planus, both clinically and
histopathologically

A

– Lichenoid mucositis

268
Q

–Dysphagia with esophageal involvement

A

systemic sclerosis

269
Q

describe lesions of heriditary hemorrhagic telangietasia (HHT)?

A

numerous 1mm-2mm red papules blanch with diascopy

270
Q

describe lesions of bullous pemphigoid?

A

Pruritus early symptom, followed by the
development of multiple, tense bullae, blisters on normal or erythematous skin

271
Q

color of squamous papilloma depends on?

A

amount of keratin

272
Q

Most common collagen vascular/connective
tissue diseases

A

Lupus erythematosus

273
Q

-development of sebaceous glands correlates with _______. Often seen on _______, once achieve _ to _ mm size, ___________ growth.

A

Sebaceous hyperplasia

puberty.

forehead,

1 to 2 mm size,

minimal to no further

274
Q

___________- most common site for recurrent HSV-1 is _________ and/or ____________

A

Herpes labialis- most common site for recurrent HSV-1 is vermilion border and/or adjacent skin of lips

275
Q

-develops due to ______

A

Dentigerous cyst-develops due to fluid entrapment between crown of impacted tooth and reduced
enamel epithelium.

276
Q

-look for

A

Condensing osteitis-look for tooth or teeth with deep caries in associated area.

ORAL PATHOLOGY (3 decks)

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